Summary Report for FSPSAs Initiated During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs starting between: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 8331 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 5 5 26.319048 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 26.319048 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 66 88 63.482041 $3078.8900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 3.166667 $46.4900 $14.6800
EXIT -EXIT EXIT ASSESSMENT 82 84 102.239544 $5111.9700 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 50 50 86.532874 $6489.9800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 36 37 72.000000 $5400.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 32.000000 $2400.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 115 122 225.038353 $12489.6400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 50.500000 $2802.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 31 59.500000 $4462.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 16 30.500000 $2287.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 6.100000 $305.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 1.927778 $99.1100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 11 10.583333 $544.0900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 3.846576 $197.7500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.265753 $13.6600 $51.4200
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 1.094445 $56.2700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 3.027778 $155.6600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.515297 $129.3100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 3.000000 $154.2300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 12 14 8.188813 $420.9900 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.980822 $50.4200 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.356164 $18.3100 $51.4200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 323 538 823.131952 $50168.0400 $60.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 21 78.416949 $392084.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.498630 $24.9300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 147 170 268.830299 $13441.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 14 16 15.113097 $755.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 13.116667 $327.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 570 880 3751.309891 $187565.5400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 8.000000 $400.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 301 424 1702.509156 $85125.4800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 6 18.666667 $933.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 5 23.066667 $576.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 76 335.445242 $16772.2800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.500000 $62.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 538 756 3057.546398 $152877.3600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 5 18.733334 $936.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 29.066668 $726.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 29 434.195238 $21709.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 121 172 3058.990469 $152949.5700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 19 211.428571 $10571.4300 $50.0000
INTR -T1013 INTERPRETER 60 126 413.640375 $20682.0200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 723 2150 20565.966384 $246791.6600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 18 295.571428 $21269.3300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 27.714286 $1994.3200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 11 13 258.571427 $18606.8100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 18 220.571431 $15872.3100 $71.9600
TRAV -TRAVS Travel by mile 903 2863 1129348.389696 $502560.0400 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 947 7788 1164161.858970 $1865806.9800 $1.6000
-------------------------------------------------------------------------------------------------------------------------------------
Total 8331 1165011.309970 $1915975.0200 $1.6400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1009